To improve mental health care, these alumni are building support systems for vulnerable populations.
It’s estimated that more than one in five American adults live with a mental illness. The COVID-19 pandemic put an additional strain on our nation’s psyche, already heavy under the weight of gun violence, economic distress, the opioid crisis, and much more.
While medications for depressive disorders and antipsychotics have improved in the past few decades and new treatment models show promise, much of mental health care has been slow to progress. Stigma, lack of resources, and a tradition of reactive — instead of proactive — approaches to care are just some of the reasons that growth in the field has been stymied.
But many mental health professionals, including generations of Colgate alumni, are hoping to build better bridges to education, comprehensive care, and recovery resources through innovative programs and partnerships.
Integrating Care
When Peter Brown ’63 first started eyeing retirement, he knew exactly what would come next: He wanted to create an organization that would improve the quality of behavioral health care. So, with the help of Alden “Joe” Doolittle ’67, an executive in health care management, Brown did just that, establishing the Institute for Behavioral Healthcare Improvement (IBHI) in 2004. Behavioral health is an umbrella term for investigating the effects of thought and emotions on behavior and includes mental health, but also factors like addiction and social disorders.
“I believe there are three major things that need to change about behavioral health care,” says Brown, who spent more than four decades working in New York state mental health departments and the legislature. “We need to measure our results when we implement new programs or treatment models and share the data, integrate general health care and behavioral health care, and develop prevention efforts that identify mental health issues early on and effectively work to stop the devolution of the diseases to the point where people become incapacitated.”
As executive director of IBHI, Brown advocates for integrating mental health services into the overall health care system and working to reach people before they are in crisis, not just after. Doolittle was Brown’s co-director for six years and continues to serve as a senior adviser.
IBHI is modeled after the Institute for Healthcare Improvement (IHI), a private nonprofit dedicated to advancing and sustaining better outcomes in health through science-driven solutions. Brown was first introduced to IHI in the mid-1990s when he was serving as deputy commissioner for the New York State Office of Mental Health. After attending a program about the organization’s work, he left thinking that many of the core concepts — including a proactive, holistic, and strategic approach to integrating systems of care — could be valuable for behavioral health care, too.
IBHI’s first effort, and the one that Brown says has continued to be the most sought after, focused on improving the operation of emergency departments in the way they serve people with behavioral health problems.
“Many times, people with serious behavioral health issues are taken to emergency departments, and at least in the larger metropolitan areas of New York, we have comprehensive psychiatric emergency services available,” says Brown. “But in most places around the nation, the people who wind up trying to serve this group of people with emergency circumstances have relatively little training in serving that population.”
To address this issue, IBHI is set up as a national learning organization that seeks to connect health care experts, administrators, and criminal justice professionals both to each other and to evidence-based methodologies that can improve outcomes and quality of care.
“One of the big problems we have in this field is that we have built up such a large organization of care that there’s a lot of inertia to the system; we like to keep doing things the way we’ve been doing them,” says Brown. “We need to collect data and share it across the world so that we can understand how we can make a better product.”
“We need to stop separating behavioral health from the rest of health care.”
Peter Brown ’63
IBHI has also developed programs, conferences, and webinars on improving the relationship between criminal justice and behavioral health to further those connections, as well as small-group programs for senior leaders in the mental health and health care fields to talk about concerns and potential solutions.
“We need to stop separating behavioral health from the rest of health care,” says Brown. “We have almost no prevention or mitigation methodologies that we implement. We let symptoms build up to the point that they become a huge problem, and then we rush in and try to solve it. Prevention is far more effective.”
Creating Spaces for Conversation
In 2012 Ellen Dalton ’74 lost her 24-year-old daughter, Nancy, to suicide. Dalton had spent her career administering mental and behavioral health programs for young people in Massachusetts, and while she knew that Nancy struggled, she says suicide is not something a parent ever thinks could happen in their family.
“Being in the field, I just couldn’t understand how she could slip through my fingers like that,” Dalton says. “I did a lot of soul searching to peel back the layers to understand more about suicide. What I realized, as I looked at suicidal behavior and thinking in young people, was that it was rampant.”
Out of her grief, The NAN Project was born. Named after her daughter, the project aims to promote mental health awareness and suicide prevention programs for young people.
Suicide is the second leading cause of death in children ages 10–14 and adults 25–34, according to the Centers for Disease Control and Prevention. For people ages 15–24, it is the third leading cause.
“The reason, I believe, is that we don’t talk about it,” says Dalton, who is now CEO of The NAN Project after retiring from work that focused on juvenile justice and behavioral health. “Nancy fit in very well and was able to mask her symptoms for many years. So, the goal when we started The NAN Project was to get the conversation going at a young age. The model we came up with was based on the idea that young people talking to students and sharing what they’ve been through is an impactful way of getting information across.”
The NAN Project launched in 2016 with a small staff that includes Dalton’s son, Jake, who serves as executive director. To get started, the team arranged focus groups — talking with young people who had struggled with mental health issues, along with their parents, educators, and other experts — to help inform building an organization to deliver education, prevention, and intervention strategies to school staff members, parents, and their children.
The program relies on a peer-to-peer model that utilizes teenagers and young adults who visit schools across Massachusetts to educate middle and high schoolers about mental health, help destigmatize it, and connect those seeking assistance to trusted adults as well as other peers who have experienced mental health struggles.
“We recruit young people who have had their own struggles,” says Dalton. “They work with us, go through an intensive four-day training, and then [get] a lot of coaching. We help them craft their story, which is about their struggles with mental illness and also about the turning points, the things that changed their trajectory to put them on a path to recovery. It is so courageous.
And the kids in the classroom, they’re hungry for this information.”
Peer mentors also work with clinicians to provide “social emotional learning circles” in school settings. Dalton says these groups bring students together who might need extra support to talk about different coping skills, relationships, managing stress, and other topics related to mental well-being.
The NAN Project is student focused, but the organization has also created professional development opportunities, mental health lesson plans, evidence-based training for school staff members, workshops for parents and caregivers, mental health and suicide prevention training for first responders, and outreach for young people in Massachusetts who want to learn how to help those around them struggling with suicidal thoughts.
“Over the years, I’ve seen the conversations about mental illness, about suicide, beginning to open up,” says Dalton. “Bottom line is that it should be something kids learn about at an early age. We need to make sure they can have the necessary conversations and know where to turn. The stigma is not going to go away. But it can’t stand in the way of someone getting the help they need — that can be deadly.”
Supporting Others as a Peer
The power of peer-to-peer support groups is one that resonates strongly with Aqil Un Nabi ’17. He’s a mental health specialist working with young adults who are experiencing early psychosis and coping with diagnoses of schizophrenia and schizoaffective disorder. At Colgate, he majored in political science with a minor in film and media studies and enjoyed the challenge of
a rich curriculum. But in the latter half of his senior year, a confluence of factors led to his first experience with psychosis — which is when someone’s thoughts and perceptions have been disrupted to a point of disconnection from reality.
“There were a lot of moving parts in terms of stressors, including the course load and leaving some of my friends at Colgate; I was kind of worked up about what was going to happen next and had a lot of anxiety about that,” says Nabi.
He was hospitalized, after which he was connected to resources at OnTrackNY, a mental health treatment program in New York State. It’s specifically for young people ages 16–30 who have recently started experiencing symptoms of schizophrenia or have had acute episodes of psychosis.
“Because of my political science experience and having learned skills as a communicator in therapy, I was able to explain what was going on with me,” Nabi recalls. “I could speak clearly about a lot of the cognitive distortions, the racing and intrusive thoughts that were going on.” After Nabi finished the program as a participant, he was referred for a position at OnTrackNY as a peer specialist.
Nabi recently celebrated three years of full-time employment at OnTrackNY in Washington Heights, New York City, where he is helping young people the same way others helped him when he first started his recovery journey.
OnTrackNY’s coordinated care system ensures that each individual has their own team of psychiatrists, therapists, nurses, and supportive education specialists who work together cohesively to provide treatment and assistance. Peer specialists, like Nabi, are also an integral part of the team.
“We help people pick up after having suffered some setback and develop the skills of resilience,” he says. “We want to get them back on track, whether that’s in terms of a career, school, or just life in general.”
Nabi typically meets with participants in the clinic or on calls when they have recently been released from the hospital and are disoriented.
“I first make room to listen to what’s going on and help them make sense of it all,” he says. “Then, through worksheets, dialogue, and just connecting and repeatedly working with each other, we build a road map for recovery together.”
Another aspect of his work is running group programs, including virtual social hours, personal growth workshops, and outings that might include a movie, a museum visit, or even playing a basketball game.
“These activities provide a collaborative space for them to learn life skills, but I also want to make it an environment where the process of getting better feels a bit more fun and connected,” says Nabi.
In 2023 Nabi was chosen to present about his experience as a participant in and a provider for OnTrackNY at the first Early Psychosis Care Conference sponsored by Missouri Institute of Mental Health. He hopes to have more opportunities for collaborations across the country and maybe even get into consulting one day. But for now, he appreciates the chance to connect with OnTrackNY program participants and form reciprocal relationships.
“The peer-to-peer model provides an intimate connection,” says Nabi. “Having another person as a guiding point who has gone through some of the same challenges but is now working in a capacity to help others thrive offers a positive marker that they can learn from. Just because you experienced mental health challenges, doesn’t mean it should stop or limit you from doing the things you want to do.”
A Holistic Continuum of Care
For people experiencing severe mental health disorders in nontraditional settings, the right support can be extremely hard to piece together. That’s why Chris von Zuben ’92, a clinical manager and licensed psychologist working with the Philadelphia Department of Behavioral Health & Intellectual disAbility Services, wants to enhance or establish mental health services for populations that include people reentering the community from prison or jail, those returning from time in a psychiatric hospital or substance abuse program, and those in nursing homes.
“Human behavior was always fascinating to me,” says von Zuben, who majored in psychology at Colgate. “I found, over time, that I wanted to focus on community mental health and underserved populations who, for a variety of reasons, are reluctant to access or can’t access appropriate care.”
After earning a master’s degree in psychological services from the University of Pennsylvania and a doctorate in psychology from Temple University, von Zuben worked at WES Health System — a community mental health agency — for nearly 14 years. At WES, he fine-tuned his ability to assess individuals and families in order to identify psychiatric disorders and agree on goals as well as interventions to support their recoveries. He also helped develop specialized care services such as a Dialectical Behavior Therapy program for adults and established WES’ postdoctoral training program that helped graduate students become licensed psychologists in Pennsylvania.
In 2017 he joined the Philadelphia Department of Behavioral Health in a division that specializes in helping reduce justice involvement for individuals with behavioral health issues, be it severe mental illness and/or a substance use disorder, by offering holistic treatment and support programs.
I found, over time, that I wanted to focus on community mental health and underserved populations who, for a variety of reasons, are reluctant to access or can’t access appropriate care.”
Chris von Zuben ’92
One of the major programs that von Zuben has been involved in recently is establishing a continuum of care of services for people who are returning to the community — either from a state hospital, county jail, or prisons across the state — and have a severe mental illness like schizophrenia, schizoaffective disorder, bipolar disorder, or post-traumatic stress disorder.
Many of these individuals don’t have a place to live and need structured support to return to the community after being in jail or a hospital for many months or years. In October 2022, the Christine Gibson Peer Support House opened as the last piece of the continuum of care puzzle in Philadelphia. It’s a short-term housing or respite home where individuals can focus on getting reconnected to all the services and support they need.
“It’s all about social determinants of health — housing, employment, benefits, education, family, access to needed services — and making sure we’re getting those covered for people coming out of jail and other state facilities,” explains von Zuben. “The unique element is we wanted to utilize certified peer specialists to support the individuals in this house. This is a relatively new aspect for behavioral health services in Pennsylvania and across the nation.”
The peer specialists, similar to Nabi’s role at OnTrackNY, have the lived experience of recovering from severe mental illness or from substance use and, in some cases, the experience of having been incarcerated.
“It’s an excellent addition to an integrated approach to behavioral health: You have your psychiatrist, your therapist, a social worker, and now you have the certified peer specialist who offers living proof that you can recover and achieve your goals,” says von Zuben. “For people with severe mental illness and legal oversight who are often marginalized by society, peer specialists can offer a lot of hope.”
Von Zuben and his colleagues also help clients navigate complicated legal systems, serve as a bridge for people with brain injuries or dementia who fall in the gap between medical and behavioral health care, and are working to incorporate diversity, equity, and inclusion into their policies and programs so that people of all backgrounds and abilities have access to care and feel supported.
He’s also helped to build a program to infuse behavioral health services into nursing home care. “If you qualify for nursing home care, you will get the skilled nursing you need, but then you’re also going to get treatment for, say, schizophrenia so that you can live in a more fully supportive environment,” says von Zuben. “You can get all your needs met under one roof.”
Brown, Dalton, Nabi, and von Zuben all face barriers to the positive changes they are trying to make through their hard work. Lack of funding, struggles with bureaucratic red tape, enduring stigma around behavioral and mental health issues, and burnout from the mental labor required of providers are just a sample of the many challenges. But von Zuben, like the others, sees hope not just in his work, but also promise on the horizon for the field as a whole.
He’s noticed four areas where he believes progress is underway. “There is a growing appreciation of the impact of a trauma in people’s lives and brain injury, so that’s very valuable,” he says. Von Zuben adds that he thinks there’s an increased understanding of racial disparities in the justice system and agencies that are trying to address them. And, he says, there’s a growing number of evidence-based practices that, through research, have demonstrated they can improve people’s well-being, including people with severe mental illnesses such as schizophrenia. Lastly, “We’re seeing good progress in terms of integrating behavioral health services and medical services to better serve people,” says von Zuben.